Form NHTSA Form 1323 NHTSA Form 1323 Recruitment Screener

OMB Control No. 2127-XXXX

Expiration Date XX/XX/XXXX

Recruitment Screener

To Assess Drunk Driving/Riding Behaviors

N=2,200 (n=1,600 non-motorcycle drivers and n=600 motorcycle riders)

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2127-XXXX. Public reporting for this collection of information is estimated to be approximately 4 minutes per interview, including the time for reviewing instructions, completing and reviewing the collection of information. All responses to this collection of information are voluntary. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, National Highway Traffic Safety Administration, W51-316, 1200 New Jersey Ave, S.E., Washington, DC, 20590

Thank you for your willingness to participate in our survey. First, we would like to ask you a few classification questions. Please be assured all of your answers are completely confidential. We appreciate your honest and thoughtful responses.

1. In which of the following states do you live?

[PROVIDE A PULL-DOWN LIST OF ALL 50 US STATES, AND DC; RECORD STATE RESPONSE AND ALSO CODE INTO CENSUS REGIONS BELOW CODE TO CLASSIFICATIONS BELOW; PROVIDE AN OPT-OUT CHECKBOX FOR “None” AND THANK AND TERMINATE IF SELECTED]

New England	ME, NH, VT, MA, CT, RI	1	CONTINUE; RECRUIT MIX
Middle Atlantic	NY, NJ, PA	2
South Atlantic	WV, MD, DE, DC, VA, NC, SC, GA, FL	3
East South Central	KY, TN, AL, MS	4
East North Central	MI, OH, IN, IL, WI	5
West South Central	AR, LA, OK, TX	6
West North Central	MN, IA, MO, ND, SD, NE, KS	7
Mountain	MT, WY, CO, NM, AZ, UT, NV, ID	8
Pacific	WA, OR, CA, AK, HI	9

2. What is your gender?

[ALLOW 1 RESPONSE]

Male	1	CONTINUE; RECRUIT MIX
Female	2

3. What is your age?

[RECORD NUMERIC RESPONSE; CODE TO LIST BELOW]

Under 21	1	THANK & TERMINATE
21-24	2	CONTINUE; RECRUIT MIX
25-29	3
30-34	4
35-39	5
40-44	6
45-49	7
50-54	8
55+	9	THANK & TERMINATE

4. Which of the following best describes your total household income in 2014?

[ALLOW 1 RESPONSE; GOALS FOR QUALIFIED SAMPLE COMPOSITION MAPPING TO CENSUS DATA +/-5%]

Under $15,000	1	GOAL: 11%
$15,000 to $24,999	2	GOAL: 10%
$25,000 to $49,999	3	GOAL: 23%
$50,000 to $74,999	4	GOAL: 18%
$75,000 to $99,999	5	GOAL: 13%
$100,000 to $149,999	6	GOAL: 14%
$150,000 or more	7	GOAL: 11%
I prefer not to answer	99	ALLOW TO CONTINUE BUT SET MAX THAT MAINTAINS +/-5% ON ABOVE QUOTAS

5. Do you consider yourself to be Hispanic or Latino?

[ALLOW 1 RESPONSE]

Yes	1	GOAL FOR QUALIFIED SAMPLE COMPOSITION OF 20% HISPANIC OR LATINO BACKGROUND; CONTINUE
No	2
I prefer not to answer	96

6. Which of the following racial categories describes you? You may select more than one.

[ALLOW MULTIPLE RESPONSES]

American Indian or Alaska Native	1	CONTINUE; RECRUIT MIX
Asian	3
Black or African American	4
Native Hawaiian or Other Pacific Islander	5
White	6
I prefer not to state	99

ANALYSIS NOTE: ANALYSIS OF SURVEY FINDINGS AMONG AND BETWEEN AGE GROUPS, DIFFERENT ETHNICITIES, AND ADDITIONAL DEMOGRAPHIC GROUPINGS WILL BE CONDUCTED

7. Do you currently have a valid driver’s license for any of the following types of vehicles?

[RANDOMIZE; ALLOW MULTIPLE RESPONSES]

Motor vehicle (e.g., car, truck, van, SUV)	1	CONTINUE
Motorcycle	2
Commercial motor vehicle	3	MUST SELECT 1 OR 2 TO CONTINUE; ELSE THANK &TERMINATE
Boat	4
Moped or motor-driven cycles	5
I don’t know	97	THANK & TERMINATE
None of the above	99

ONLY ASK QH IF QG=2

8. What type of motorcycle do you ride?

[RANDOMIZE; ALLOW MULTIPLE RESPONSES; PROVIDE VISUAL EXAMPLES OF EACH TYPE; THANK & TERMINATE IF ONLY 8, 98, 99 SELECTED]

Traditional	1	CONTINUE
Cruiser	2
Sport bike	3
Touring	4
Sport-Touring	5
Dual-Purpose	6
Trike	7
Moped or Motor Scooter	8
Other (Please Specify: __________)	98
None of the above	99

9. On average, how many miles do you typically drive per week? [IF QG=1 AND 2, PIPE: “Please indicate your average mileage for each of the following types of vehicles.”]

CREATE POP UP BASED ON CLICKING “TYPICALLY” FOR “If you are unable to identify a typical week, please consider last week.”

[RECORD NUMERIC RESPONSE; CODE TO LIST BELOW; PROVIDE OPT-OUT BOX FOR “I don’t know” AND THANK & TERMINATE IF SELECTED FOR BOTH]

[PIPE APPLICABLE VEHICLES BASED ON QG AND QH]	Motor Vehicle [QG=1]	Motorcycle [QH=1-7]
Less than 10 miles	1	1	SEE SCREENING CRITERIA BELOW
10-14 miles	2	2
15-19 miles	3	3
20-24 miles	4	4
25 miles or more	5	5

MUST SELECT QI=2-5 FOR AT LEAST ONE TYPE OF VEHICLE.

IF QH MOTOR VEHICLE=2-5, CLASSIFY AS “NON-MOTORCYCLE.” IF QH MOTORCYCLE=2-5 CLASSIFY AS “MOTORCYCLE.” IF BOTH QH MOTOR VEHICLE AND MOTORCYCLE=2-5 SELECTED, USE LEAST FILL FOR NON-MOTORCYCLE AND MOTORCYCLE CLASSIFICATIONS TO ENSURE SAMPLE:

NON-MOTORCYCLE: n=1,600; MOTORCYCLE: n=600

10. During the last 12 months, how often did you usually have any kind of drink containing alcohol? By a drink we mean half an ounce of absolute alcohol (e.g. a 12 ounce can or glass of beer or cooler, a 5 ounce glass of wine, or a drink containing 1 shot of liquor). Please feel free to estimate and provide an honest response.

[ALLOW ONE RESPONSE]

Every day	1	CONTINUE
5 to 6 times a week	2
3 to 4 times a week	3
Twice a week	4
Once a week	5
2 to 3 times a month	6
Once a month	7	THANK & TERMINATE
3 to 11 times in the past year	8
1 or 2 times in the past year	9
I don’t know	97

QK, QL, QN, QO, QP WILL BE USED TO QUALIFY RESPONDENTS BASED ON CLASSIFICATION SCHEME ON PAGE 6.

11. In the past month, what is the largest number of drinks of alcohol you consumed at one time while you were away from home? Please feel free to estimate and provide an honest response.

[RECORD NUMERIC RESPONSE]

[FOR MEN (QB=1), THANK & TERMINATE IF QK<4; FOR WOMEN QB=2, THANK & TERMINATE IF QK<3; PROVIDE OPT-OUT BOX FOR “I don’t know” AND THANK & TERMINATE]

12. Thinking about the time during the past month when you consumed the largest number of drinks at one time while away from home, over the course of how many hours did you have those [PIPE RESPONSE FROM QK] drinks? Please feel free to estimate and provide an honest response.

[RECORD NUMERIC RESPONSE; PROVIDE OPT-OUT BOX FOR “I don’t know” AND THANK & TERMINATE]

13. And which of the following activities did you do before drinking those [PIPE RESPONSE FROM QK] drinks while away from home?

[RANDOMIZE LIST; ALLOW MULTIPLE RESPONSES]

Assigned a designated driver	1	THANK & TERMINATE
Planned a ride with a friend or family member at the end of the night	2
Called a taxi or car service to arrange a ride at the end of the night	3
Located a taxi or car service to call if necessary at the end of the night	4
I don’t know or I don’t remember	97
I did not do any of these	99	CONTINUE

14. After you drank those [PIPE RESPONSE FROM QK] drinks away from home, how did you get home or to the place where you were staying? Please select the answer that best applies.

[RANDOMIZE LIST; ALLOW 1 RESPONSE]

I rode with a designated driver who had no alcoholic beverages	1	CONTINUE
I rode with a non-drinker that was not serving as a designated driver	2
I used a taxi or car service	3
I used public transportation	4
I rode with a driver who had some alcohol but less than me	5	CLASSIFY AS “AT RISK”
I rode with a driver who had as much alcohol as me	6
I rode with a driver who had more alcohol than me	7
I drove myself in a motor vehicle (e.g., car, truck, or SUV)	8
[ASK OF MOTORCYLES ONLY] I rode my motorcycle	9
Other (Please Specify: __________)	98	CONTINUE
I don’t know or I don’t remember	97
I did not go anywhere	99

15. On a scale of 1 to 7 where 1 means “Completely disagree” and 7 means “Completely agree,” please tell me how much you agree with each of the following statements about yourself.

[RANDOMIZE ROWS; ALLOW 1 RESPONSE PER ROW]

IF 3 OUT OF 7 ANSWERED IN APPROPRIATE GREY AREAS, CLASSIFY AS “ELIGIBLE OR OF INTEREST” BASED ON CLASSIFICATION ON PAGE 6; CONTINUE

	1 – Completely disagree						7 – Completely agree
I only use a designated driver if absolutely necessary	1	2	3	4	5	6	7
I know when I have had too much to drink to drive safely	1	2	3	4	5	6	7
It is better to be safe than sorry when it comes to driving after drinking	1	2	3	4	5	6	7
I would not get upset if a friend or family member tried to stop me from driving after I had had a few drinks	1	2	3	4	5	6	7
It is hard to have a good time when I’m going out if I have to be the designated driver	1	2	3	4	5	6	7
I typically do not worry about how much alcohol I am drinking	1	2	3	4	5	6	7
I sometimes do not realize that I have had too much to drink	1	2	3	4	5	6	7

16. Have you ever been stopped by the police for reckless or drunk driving? Please feel free to estimate and provide an honest response.

[RECORD NUMERIC RESPONSE; CODE TO LIST BELOW; PROVIDE OPT-OUT BOX FOR “I don’t know” AND THANK & TERMINATE]

Yes – one time	1	CONTINUE
Yes – more than once	2
No	3
I don’t know	98
I prefer not to answer	96

CALCULATE “DRINKS PER HOUR” =QK/QL

BASED ON RESPONSES TO QJ, QK, QM, QN, OR QO USE BELOW CLASSIFICATION CRITERIA:

CLASSIFY AS “ELIGIBLE OR OF INTEREST ” IF ANY:

• DRINKS PER HOUR>1.5

• QN=5-9

• AT LEAST 3/7 QO= DISAGREEMENT/AGREEMENT (BASED ON SHADING ABOVE)

• QP=1,2, OR 96

ELSE, THANK & TERMINATE

Continue to Survey

NHTSA Form 1323 Page 9